Introduction to Health Care Services: Foundations and Challenges

Bernard J. Healey, Tina Marie Evans

• Publisher: Jossey-Bass
• Year: 2014
• ISBN:
  9781118450147
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

A comprehensive guide to the structure, synergy, and challenges in U.S. health care delivery

Introduction to Health Care Services: Foundations and Challenges offers new insights into the most important sectors of the United States' health care industry and the many challenges the future holds. Designed to provide a comprehensive and up-to-date understanding of the system, this textbook covers the many facets of health care delivery and details the interaction of health, environments, organizations, populations, and the health professions. Written by authors with decades of experience teaching and working in health care administration and management, the book examines the current state and changing face of health care delivery in the United States. Each chapter includes learning objectives and discussion questions that help guide and engage deeper consideration of the issues at hand, providing a comprehensive approach for students. Cases studies demonstrating innovations in the delivery of health care services are also presented.

Health care administration requires a thorough understanding of the multiple systems that define and shape the delivery of health care in the United States. At the same time, it is important for students to gain an appreciation of the dilemma confronting policy makers, providers, and patients in the struggle to balance cost, quality, and access. Introduction to Health Care Services: Foundations and Challenges is an in-depth examination of the major health care issues and policy changes that have had an impact on the U.S. health care delivery system.

• Includes information on U.S. health care delivery, from care to cost, and the forces of change
• Focuses on major industry players, including providers, insurers, and facilities
• Highlights challenges facing health care delivery in the future, including physician shortages, quality care, and the chronic disease epidemic

The U.S. health care system is undergoing major reform, and the effects will ripple across every sector of the industry. Introduction to Health Care Services: Foundations and Challenges gives students a complete introduction to understanding the issues and ramifications.

PART ONE

OVERVIEW OF HEALTH CARE SERVICE DELIVERY

Chapter 1
An Overview of Health Care Delivery in the United States

Bernard J. Healey

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Learning Objectives

After reading this chapter you should be able to

• Describe the major problems found in the U.S. health care delivery system.
• Describe the need for reform of the present system of health care delivery in the United States.
• Discuss how health care services are financed in the United States.
• Explain the advantages of a focus on health outcomes rather than activities in the health care delivery system.
• Demonstrate the value of preventing disease rather than mostly attempting to cure disease.

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What has happened to the health care delivery system in the United States, once considered the best system anywhere? This is a complicated question, and the answer you will hear depends on the biases of the group you are talking to. Physicians blame insurance providers, insurance providers blame employers, employees fault government regulation, and the consumers of health services blame everyone. This book is intended to help you better understand all of the important sectors of the U.S. health care system while developing an appreciation for all that needs to be done to improve health outcomes at a price those paying for health care can afford.

The health care delivery system in the United States is in a crisis situation that threatens its long-term survival. At the same time, this crisis offers tremendous opportunities for positive changes that will lead to a better system of care for all. The U.S. health care delivery system costs more than the system of any other industrialized country and yet delivers far fewer positive health outcomes to its population. Several indices of health care in America, such as infant mortality, fall below the results found in other industrialized countries, despite our extensive use of the newest and most expensive technology (Budrys, 2012).

According to Fuchs (1998) the major problems found in the U.S. health care system involve costs, access, and health levels and outcomes. There is also a serious problem with the quality of the health services received by many Americans. The cost of health care delivery has continued to rise for the last several years and was a leading reason why Congress recently passed the health care reform legislation titled the Patient Protection and Affordable Care Act of 2010 (ACA). The ACA is a federal statute designed to increase the availability of health care coverage to most Americans and to improve the quality of that care. This new legislation attempts to solve the access problem for the millions of Americans who are without health insurance, and it should cause the number of uninsured people in the United States to drop dramatically in 2014. Unfortunately, this new legislation pays far less attention to health levels and outcomes, or wellness, in the U.S. population. We are currently dealing with an epidemic of chronic diseases, and these diseases and their complications are responsible for 80 percent of current health care costs.

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Patient Protection and Affordable Care Act of 2010 (ACA)

Signed into law on March 23, 2010, the ACA seeks to increase the quality and availability of health care coverage for most Americans.

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Many health policy experts argue that the problems with costs, access, health levels, and quality are symptoms of a health care delivery system that is in immediate need of tremendous reform. This chapter will explore various aspects of these problems and their causes.

Health Care Costs

The cost of health care delivery has become one of the major problems confronting the United States as its health care system seeks to achieve reform. Forty years ago a typical American family spent approximately $450 per year on health care delivery, which at that time represented 8 percent of the gross domestic product (GDP) (Fuchs, 1998). In 2010, an average American family spent $8,402, representing over 17 percent of GDP. Carroll, Chapman, Dodd, Hollister, and Harrington (2013) argue that health care costs will continue to rise and, by the year 2020, will total $4.6 trillion, representing almost 20 percent of GDP. This cost escalation will occur despite the fact that the new health care reform law will have been fully implemented by 2020. In a recent article, Fuchs (2013) points out that even though the escalation in health care costs has slowed in the last few years, if it returns to its prior level, the United States will be spending over 30 percent of GDP on health care in 2040. Baumol (2012) calls such rapidly rising costs cost disease, an economic ailment that is forcing a crisis of public choice on how limited federal dollars are spent each year. Baumol argues that education, the performing arts, and health care all suffer from cost disease due to the fact that the quantity of labor required to produce these services is very difficult to reduce. In other industries, in contrast, productivity increases have occurred, allowing the costs of products to be lowered. Baumol also notes that the price increases for health care are “real price increases”: that is, they are above the U.S. rate of inflation. This cost escalation is unsustainable and will result in this country being unable to deliver basic health care and many other goods and services in the near future unless we gain control over rising costs.

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cost disease

The cost increase that occurs when the quantity of labor required by a product or service cannot be reduced, as in education, health care, and the performi...